COPD

Question 1

Delayed and incomplete emptying of the lung during __ is Obstructive disease. COPD is the __ leading COD, its cause be a mixture of ___ __ disease and small airway disease.

Answer 1

1) exhalation
2) fourth
3) parenchymal alveolar

Question 2

___ is the most common RF for COPD. Inflammation of lung causes small airways to __, chronic inflammation leads to destruction of lung parenchyma, resp. bronchioles, & alveoli. This leads to decreased ___ __.

Answer 2

1) Smoking
2) narrow
3) lung recoil
Also watch for recurrent LOWER resp. tract infections, other air pollution, & family hx of COPD as a RF

Question 3

The 6 COPD diseases we discuss are…

Answer 3

CF
Chronic Bronchitis
Emphysema
Asthma
Bronchiectasis
COPD (Nitric oxide synthase)

Question 4

Signs of lung HYPERinflation include __ of shld girdle, horizontal ribs, ___-shaped thorax, __/__ diaphragm.

Answer 4

1) elevation
2) barrel
3&4) low/flattened

Question 5

Due to COPD leading to abnormal gas exchange, your ___ __ __ values will be abnormal. Other dx testing used to indicate COPD are PFTs, CXR, __-__ posture, and aucultations (prolonged __).

Answer 5

1) arterial blood gas (ABG)
2) fwd-leaning posture
3) expiration

Question 6

3 main symptoms for COPD are coughing, dyspnea, & SOB. Dyspnea is __ overtime, worse with __, & (persistent/intermittent). Cough will be chronic with a recurrent (what cough sound?). Cough may be (persistent/intermittent) and NONproductive. However, any pattern of chronic ___ __ may indicate COPD.

Answer 6

1) progressive
2) exercise
3) persistent
4) wheeze
5) intermittent
6) sputum production

Question 7

T/F: COPD is associated with smaller total lung capacities (TLCs) and smaller residual volumes (RVs).

Answer 7

FALSE; associated w/ LARGER volumes/capacities

Question 8

___ is used to quantify the degree of airway obstruction and is the GOLD standard for diagnosing COPD.

Answer 8

Spirometry / PFTs

Question 9

Normal FEV1/FVC ratio = __
FEV1/FVC ratio indicating COPD = __

Answer 9

Norm = 0.75-0.8 (75-80%)
COPD = < 0.70 (70%)
also FEV1 (Norm=4L) and FVC (Norm=5L) will be decreased

Question 10

The ___ __ __ __ is a subjective measure that evaluates the severity of breathing difficulty. Another subjective measure that evaluates the impact of COPD on an individual’s life is the __ __.

Answer 10

1) Modified MRC Dyspnea Scale
2) CAT Assessment

Question 11

The classification for COPD severity has 4 Gold levels. Describe each level.

Answer 11

Gold 1 (mild), FEV1 =/> 80% of predicted
Gold 2 (moderate), FEV1 = 50-80% of predicted
Gold 3 (severe), FEV1 = 30-50% of predicted
Gold 4 (very severe), FEV1 = <30% of predicated

Question 12

COPD is a progressive disease that gets __ overtime. The ___ Index measures (4). A score of __ to __ is associated w/ a HIGH mortality rate in 52 mo. (13 yrs). End-stage COPD results in __ __.

Answer 12

1) worse
2) BODE index
3) Body mass, Obstruction, Dyspnea, Exercise
4) score of 7 to 10
5) Cor pulmonale (RV failure)

Question 13

The main goals for tx of Stable COPD are to reduce symptoms and reduce risk. To reduce symptoms, PT should focus on relieving symptoms, improving ___ __, and improving health status. To reduce risk, PT should focus on preventing __ __, preventing & treating __, and reducing mortality.

Answer 13

1) exercise tolerance
2) disease progression
3) exacerbations

Question 14

Medical management of COPD include meds, vaccinations, tx of sleep disorders, pulmonary rehab/exercise training, and surgical excision of lung vol reduction (LVRS). What is a MODIFIABLE factor that the pt can do to manage COPD?

Answer 14

STOP SHMOKINGGG
(smoking cessation)

Question 15

Meds to tx COPD include bronchodilators, A1 antitrypsin, & 3 more meds.
1) What are they?
2) What dx is rare for antitrypsin to be used to tx?

Answer 15

1) glucocorticoids, antitussives, O2
2) emphysema

Question 16

Supplemental O2 is indicated to maintain SaO2 at ___or more for pts w/ arterial __. If pt has Right HF or erythrocytosis & a PaO2 b/w 55 & 60 OR if pt’s PaO2 is <55 or SaO2 <88, this indicates arterial __. Recheck pt’s O2 in 60-90 days to test __ of supplemental O2 if to see if it’s still indicated.

Answer 16

1) 90%
2&3) hypoxemia
4) effectiveness

Question 17

T/F: According to research, evidence is strong for pulmonary rehab to reduce symptoms (discussed in previous flashcard), reduce S&S of anxiety and depression, & reduce hospitalization among pts with an exacerbation (4wks from prior hosp.).

Answer 17

true

Question 18

T/F: Research evidence is also strong for tx of COPD with a combo of PT edu, self-management interventions, and integrated care programs.

Answer 18

FALSE; only self-management interventions have strong evidence. Edu ALONE is NOT effective, and integrated care programs show no benefit currently.

Question 19

Implications for PT tx include strength & endurance training, postural re-edu, __ stretching, edu for recovery from ___ positions, ambulation w/ a __ __, ctrled breathing at __ & w/ __, & ___ __ (think sputum).

Answer 19

1) thoracic
2) SOB
3) RW
4&5) rest & w/ activity
6) secretion clearance

Question 20

Time to play…NAME THAT DX!!
-Genetic multisystem disorder in kids/young adults affecting organs w/ epithelium (pulmonary & pancreatic).
-Mucus stasis occurs in these conduction organs (i.e. airways, glands, small intestine, pancreas) causing failure of airways to clear mucus normally.

Answer 20

Cystic Fibrosis

Question 21

T/F: Cystic Fibrosis does not affect salt and water transport, so if the Sweat test shows elevated chloride levels (≥60) then CF is NOT the dx.

Answer 21

False. it causes abnormal transport & elevated levels indicate CF
SALTY BABYYYY

Question 22

CF results in recurrent lung infiltrates, __ of nutrients, maldigestion & fecal __, failure to thrive w/ __ (oily/fatty stool), & pancreatic insufficiency. Describe the persistent cough that CF can cause one to experience.

Answer 22

1) malabsorption
2) impaction
3) steatorrhea
4) cough become productive with purulent, green sputum

Question 23

S&S for CF include productive cough/sputum production, incr. temp (low-grade), ___ respiration rate, incr. __ blood cell count, weight/appetite __, & decr. activity levels.

Answer 23

1) incr.
2) white
3) loss

Question 24

Other than the sweat test, what is a screen for indicating CF in a newborn?

Answer 24

CFTR mutation screen

Question 25

The goals of medical management of CF include ctrlling lung __, mucus clearance, & improving __ status.

Answer 25

1) infection
2) nutritional

Question 26

Prognosis of CF has had a dramatic incr. in age of survival. What is a scoring system for CF pts that’s based on chest XR findings? How many categories are on this instrument and how is scoring interpreted?

Answer 26

Brasfield Scoring System:
-Normal/max score = 25, the lower the greater disease severity
-5 Categories
I don’t think he will ask about what the categories are, I think it’s most important for us to know this is base on chest XR and it determines severity of CF

Question 27

PT Implications for treating CF are.. secretion __ techniques, ctrlled __ techniques, exercise and strength training, __ muscle training, __ stretching exercises, & postural reeducation.
What are 2 things a pt can choose to do that can aid in preventing CF?

Answer 27

1) clearance
2) breathing
3) inspiratory
4) thoracic
5) genetic counseling & screening for CF carrier status

Question 28

NAME THAT DX!!
-Chronic inflammatory disorder of airways w/
“Episodic” obstruction caused by viral or allergen exposures, exercise, inhalation of cold air.
Hint: greek word for panting

Answer 28

Asthma

Question 29

S&S of asthma include SOB, chest __, & what type of cough sound?
What are 3 special types of asthma?

Answer 29

1) tightness
2) wheezing
3) seasonal, exercise-induced, & asthmatic bronchitis

Question 30

Medical management of asthma include emphasis on (short/long) ctrl, identifying/eliminating causes, and meds. PFTs can help evaluate current function, but also measure ___ of obstruction after __ administration.

Answer 30

1) long term ctrl
2) reversibility
3) bronchodilator

Question 31

PT implications for asthma are similar to the ones for CF except interventions should not begin until what?

Answer 31

Medication regime is established

Question 32

NAME THAT DX!!
-Characterized by destruction of alveolar walls and enlargement of air spaces distal to terminal bronchiole
-Smoking is a MAJOR CAUSE

Answer 32

Emphysema

Question 33

T/F: The blue bloater and pink puffer are not accurate & respectful descriptions of pts w/ chronic bronchitis & emphysema, however they are still politically correct descriptions used today.

Answer 33

False; they are NOT politically correct, accurate, or respectful in today’s world

Question 34

NAME THAT DX!!
-Hypersecretion of mucus begins in large airways and progress to smaller airways
-Chronic productive cough for 3 months/per year for 2 consecutive years

Answer 34

Chronic Bronchitis

Question 35

Chronic bronchitis S&S include the productive cough, rhonchi/wheezing, and elevated __. What are 2 more S&S (think color & weight)

Answer 35

1) hemoglobin
2) overweight and cyanosis

Question 36

Emphysema S&S include being underweight, severe __, and a quiet chest. What S&S would be seen on a chest XR?

Answer 36

1) dyspnea
2) hyperinflation of lungs & flattened diaphragm

Question 37

Bronchiectasis is (chronic/acute) inflammation/infection that causes broncho____ & is (reversible/irreversible).

Answer 37

1) chronic
2) dilation
3) IRREVERSIBLE

Question 38

Bronchiectasis S&S include cough w/ sputum of ___ secretions composed of think yellow-green plugs. Sputum is greatest at what time of day? Another S&S is __ (bloody cough) and __ & chronic lung infections.

Answer 38

1) micropurulent
2) in the morning
3) hemoptysis
4) recurrent

Question 39

In addition to auscultations, CT scans, PFTs, & blood work (ABGs), what are 2 more dx tests used to dx Bronchiectasis?

Answer 39

1) sputum testing (for flu & P. aeruginosa)
2) evaluation of gastroesophageal reflux disease

Question 40

Medical management for bronchiectasis include managing underlying condition & acute exacerbations, long-term management, & the main goal..which is to reduce the # of ___ and improve QoL

Answer 40

exacerbations

Question 41

Bronchiectasis PT implications are similar to the other dx we’ve discussed but it only consists of __ clearance, __ breathing, and __/__ training

Answer 41

1) secretion clearance
2) ctrlled breathing
3) strength & endurance training

Question 42

NAME THAT DX!!
___ is the combination disease.
literally this is the only slide/note on this dx in the entire ppt lol

Answer 42

COPD (NOS)